(342) Partnership in Education-CF Center Patient Education Practices on Home Nebulizer Care in Relationship to Published Guidelines

Background: In 2013, the CF Foundation published Infection Prevention and Control (IPC) Guidelines to advise on home, inpatient and outpatient practices. However, studies have shown that families, despite reported standardized education in clinic, have difficulty with adherence to IPC guidelines. Previous studies have examined center adherence to clinic IPC practices and delivery of patient education within clinic visits but have not examined if centers are consistently reinforcing published IPC guidelines when educating patients on cleaning and disinfection of home nebulizers.

Methods: To examine these educational practices, survey questions were developed internally within the context of the 2013 CFF IPC Guidelines. 129 individuals participated in the survey between June 2021 and August 2021. Participants were not required to answer all the questions to complete the survey.

Results: All participants recommend cleaning and disinfection methods consistent with IPC guidelines. Boiling was the most frequently recommended disinfection method with 86% (n=89) of respondents recommending this method to their patients. However, approximately 35% of respondents who recommended using multiple methods noted that recommendations were largely influenced by partnering with families. Despite more than 70% of all participants (73%, 72/99) self-reporting patient education consistent with IPC guidelines, less than 50% of participants provided patient education that was consistent with IPC guidelines (42%; 34/99) based on further responses on recommended cleaning and disinfection practices. Centers that performed patient education more frequently than once per year, had better consistency with IPC guidelines (p=0.0422, Figure). The largest discrepancy in patient education was the time interval between performance of nebulizer care after respiratory treatments. The majority (73%) reported educating patients to perform daily nebulizer disinfection (75/103 participants) with 39% (28/72 participants) specifying that patients should not reuse nebulizers prior disinfecting them. Interestingly, only about 9% of participants, recommended disinfecting after each nebulizer treatment (9/103). 11 and 8 participants recommended patients to disinfect weekly or several times per week respectively. Large centers were less likely to be consistent with IPC guidelines for both cleaning and disinfection (18% vs 48% for small centers, P=0.028). There was no difference geographically in recommendations based on region (P=0.468).

Conclusions: While most CF centers, regardless of location or size, educate families appropriately regarding cleaning and disinfection methods there is variability around how often the guidelines are reviewed and exact practice. Specifically, the recommended time interval between respiratory treatments and nebulizer cleaning and disinfection appears to be highly variable among CF centers with many centers recommending daily disinfection rather than immediately after each use.

Acknowledgements: The administrative team at CFF who distributed our survey and the CF care center personnel who so kindly shared their practices.

References: Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update
Saiman L, Siegel JD, LiPuma JJ, Brown RF, Bryson EA, Chambers MJ, Downer VS, Fliege J, Hazle LA, Jain M, Marshall BC, O'Malley C, Pattee SR, Potter-Bynoe G, Reid S, Robinson KA, Sabadosa KA, Schmidt HJ, Tullis E, Webber J, Weber DJ. Infect Control Hosp Epidemiol. 2014 Aug;35 Suppl 1:S1-S67. Epub 2014 Jul 1.PMID: 25025126